Terry Lake: dad, animal lover and health minister

Newly appointed Minister of health Terry Lake.JONATHAN HAYWARD
/ THE CANADIAN PRESS

B.C Premier Christy Clark, right, hugs MLA Terry Lake as she arrives for a candidate caucus meeting in Vancouver, B.C., on Thursday May 23, 2013, after winning a majority in the provincial election.DARRYL DYCK
/ THE CANADIAN PRESS

If B.C. health minister Terry Lake were a dog, he says he’d be a terrier.

“Terriers are tenacious and tough. They know what they want and how to get it,” he said in his first major interview since being appointed health minister in June.

Lake’s professional background includes working many years as a veterinarian and animal health educator. The married father of three adult daughters started his political career as a city councillor in Kamloops in 2002 and was elected mayor from 2005 to 2008. Most recently, he was the minister of environment (2011-2013).

During an hour-long interview in his office at the B.C. Legislature, Lake teared up while talking about end-of-life care, recalling his own mother’s death seven years ago.

Q) You were born in a little village in southeast England, noteworthy for its Royal Air Force base. Your dad was an RAF electrician. In which places did you live?

A) I was born in Odiham (Hampshire) at home, delivered by a midwife. At age two, we moved to Jordan. We went back to England for two years, then over to Germany, then back to England. And then my dad decided to leave the air force.

The choices back then were (Commonwealth) countries: South Africa, Australia or Canada. My dad chose Calgary, to work for the Canadian Pacific Railway. I was 10 then and it was Canada’s Centennial year (1967). I landed in this amazing country, thinking I’d been blasted into the future because it was so different from England. We had a phone, a fridge, more than one television. These were unusual things. Great big yards, great big cars, it was like a different planet. We stayed in Calgary five years, then we moved to Peachland where my dad got a job at Brenda Mines (copper) outside of Peachland. That’s where I went to high school. My mom had a massive heart attack at age 48 and that set us all back. She survived but was never the same after that. She was a victim of smoking. I left school for a bit and then went to Mount Royal College (Calgary) to study broadcasting.

Q) The job prospects in the media must have been better then?

A) I’m not sure about that. I had a three-year career (with Canadian Press broadcast division) and got paid $650 a month in those years (1978 to 1980).

Q) What made you decide to ditch journalism to become a veterinarian?

A) You may not like this but I grew weary of the media’s need to create stories without having information to back up things. I grew frustrated with that. I knew I needed more education, so I went to Simon Fraser University. My goal was to apply to UBC medical school. Then I found out that you could apply for vet school before finishing an undergraduate degree.

My wife and I moved to Saskatoon so I could go to the University of Saskatchewan.

Q) You didn’t practise as a vet for very long.

A) I was offered the opportunity to teach at University College of the Cariboo (now called Thompson Rivers University). I always wanted to teach ... and I absolutely loved it. Did that for eight years and really enjoyed it.

Q) I’m presuming you’ve heard the cliché that animals sometimes get better medical treatment than humans. How does this square with your own experience?

A) I think people actually get very good treatment, but timely access is the big concern for some. Once people get into the system, the care is very good.

Vet treatment is different. It’s privately based; you can buy quality if you’re willing to do that. There are vets who can provide care at lower costs, for sure. I was always conscious that most (problems) can get better in spite of us. Animals are robust, and most things are transitory in nature. But that was the art and science of veterinary medicine, understanding when you needed to act quickly.

Q) Pet owners tend to commiserate over vet bills. How does the income of a vet compare with the incomes that doctors for humans get? The last national report showed that on average, family doctors make around $240,000 annually.

A) The average vet who doesn’t own his own practice might make around $90,000 to $100,000. There are huge variations, but I would suspect most family doctors make more than veterinarians, even those who own their own practice. Put it this way, I never made $250,000; not even close!

Q) Tell us about your own pets.

A) My nine-year-old dog is a lab/retriever cross named Pal (for the pet character in the children’s television show, Arthur). The 10-year-old cat is named Naslund (after Markus Naslund, the former Vancouver Canucks captain).

Q) How did your selection as health minister come about?

A) The premier met with everybody before she formed cabinet. The premier knew I was passionate about my work as environment minister. She asked me what things we should be doing as a government. We talked about the need to have the greenest LNG (liquid natural gas) industry in the world and that we needed to do more on the health promotion side of things, keeping seniors and those who are frail out of hospital and in their homes longer. I always had interest in health issues. I’ve been running for 35 years and still play soccer. Kamloops is the tournament capital so it’s sort of in our DNA to be active.

So the premier looked at me and said, ‘I never thought of you as health minister,’ and I went, ‘Whoa,’ and then she told me she was firing me as environment minister and that I’d be the new health minister.

Q) The premier overlooked two doctors in caucus who could have been health minister. Do you think your training as a veterinarian will help you as health minister?

A) I think it helps me understand the (medical) lingo, pharmacology, and the like. But when you look back, George Abbott and Kevin Falcon didn’t have medical backgrounds and they were excellent ministers. I have a personal interest, a passion for health, which naturally makes it easier to go to work. I think my background is helpful, but not required.

Q) Have you ever been hospitalized or very ill?

A) No, I haven’t. I have a mitral valve insufficiency so I get checked every five years or so.

Q) On June 10, the premier gave you and all cabinet ministers a mandate letter spelling out some of the priorities she wants you to focus on. Expanding the scope of practice for nurse practitioners is one. Is the government serious about letting nurses do some of the work done by doctors, like anesthesia?

A) We are looking at the model. I think there are professionals within the system we can discuss this with. There are currently about 250 nurse practitioners in the province. They are used in the U.S. (for anesthesia) and respiratory therapists also have expertise. Do we have to have specialists doing everything or can we use other professionals?

Q) Some nurse practitioners are finding it hard to get work because health authorities don’t have the money to pay them.

A) Obviously money is a big issue in health care. When you look at cost drivers and the increases to fund health care, if the growth in funding outpaces economic growth, then its not sustainable. I think nurse practitioners can be part of the solution. But I don’t want to over-emphasize that. We need integrated health facilities with a wide variety of health professionals.

We simply cant be everything to everybody in every community. We have to use resources carefully.

Q) The redevelopment of St. Paul’s Hospital is a Vancouver concern. What have you heard about that?

A) I know it’s been a conversation that’s ongoing. I don’t think we’ve resolved that but it’s a priority for us. I haven’t had a meeting yet with Providence or done a tour of the hospital. It’s on my ‘to do’ list.

Q) One of your first lessons in health care damage control came after it was disclosed that residential care facilities would introduce a $25 wheelchair maintenance fee to help recoup the costs of maintaining and replacing wheelchair fleets. The controversy showed just how emotionally charged issues in health can be. Could the issue have been handled differently?

A) Yeah, first of all, I think Fraser Health could have done a better job communicating. I think they should have worked with us so we were consistent in the messaging because last fall, we clarified what kinds of charges were appropriate in terms of what could be passed on to patients in care homes. So that was a lesson for me that we need to do things in a more coordinated fashion, because if you have one health authority doing this and another doing that, it sounds like we don’t have a consistent plan. We have six health authorities and they do some things differently. You can get free cable on Vancouver Island but on in the Interior region, you pay for it. It’s confusing, this patchwork approach.

Q) Should policies all be the same, from one region to another?

A) I’m not sure, but we need to communicate clearly to patients and their families what it is they are signing up for. My 82-year-old dad went out and bought a walker. He lives in Kelowna; he didn’t expect taxpayers to buy it. If someone cannot afford a mobility aid, it will be provided. There are provisions to look after those who are vulnerable. But the NDP labels this the Christy Clark wheelchair tax. I know this ministry will be utilized as a political football a lot.

Q) In what seems like one of the messiest scandals involving the health ministry, employees were fired last year over improper use and sharing of patients’ personal health records. There are lawsuits stemming from that but when the B.C. Privacy Commissioner issued a report recently, it was the ministry she faulted — for improper management of health information used for research, insufficient security, protection and controls of patient information. So weren’t the firings premature, and even inappropriate, when it was a ministry structure itself that was lacking? One gets the impression no one was minding the ship. How can you fire people for breaking rules that apparently did not exist?

A) I have to be very careful because of the ongoing investigation. But what I can tell you is there were rules in place ... that weren’t being followed. The Privacy Commissioner’s concern was there wasn’t a good compliance program. But it’s like saying, well, the bank didn’t have good enough security so it’s OK to rob it. It’s not OK to rob it, but the security still should have been better. So we’re working on that. Changes have already been implemented.

Q) Are you adding another layer of bureaucracy to ensure compliance?

A) No, not necessarily. We need to have a champion in the ministry to oversee all that, especially in this ministry, where there’s so much data, to make sure the rules are in place and so are the compliance mechanisms. You need a designated champion. We have a new assistant deputy minister (Lindsay Kislock) who’s doing an amazing job on this file, so I’m confident in her ability to get this on the right track.

Q) Health authority budgets for the next year have been set to the rate of inflation, more or less. National and international income comparisons show that doctors here are very well compensated. There are about 80 in B.C. earning over $1 million (only a handful earning over $2 million) so astronomical earnings aren’t the norm, relative to the thousands of fee-for-service doctors in the province. You’re starting negotiations with them. Are you going to tell doctors to forget about fee increases?

A) Doctors are well paid in Canada compared to most other countries. Physicians are well paid but of course they’re highly educated and work very hard. They’re also smart enough to know we have fiscal challenges. We can’t keep the system sustainable if we can’t manage cost drivers and it’s not just physicians, it’s the whole workforce. Fire engine medicine (which focuses on treatment, rather than prevention) eats up a lot of money. So everyone has to be realistic.

Q) Has government ever contemplated the introduction of an income-linked health tax? Surveys show that Canadians are willing to pay more for health as long as government actually spends the money collected on health.

A) I would argue that because 42 per cent of government spending is on health care, the taxes are progressive and are income-linked. There’s also a progressive approach to Medical Services Premiums in which people on lower incomes pay a lower rate or nothing at all.

Q) The premier wants you to consider end-of-life care as a priority. Let’s talk about the Margot Bentley case. She’s the senior with dementia whose family says she’s being force fed at the Abbotsford facility where she resides, against the instructions in her living will. Should health authorities be ignoring living wills?

A) This is a tough one. My mom died at home under a palliative care plan. I was with her, seven years ago, when she died. So I understand the need that families have to respect the wishes of their loved ones. That’s what we did with my mom.

Q) Did your mom have a living will?

A) She was on a palliative care plan. I don’t know about a living will. She was getting pain medication under a doctor’s supervision. I totally empathize with this family and I don’t think anyone should be kept alive against their will, through drastic measures, if they’ve expressed their wishes ahead of time.

But what I’m told by Fraser Health is that they are holding up a spoon with food to Ms. Bentley’s mouth and she is accepting food and swallowing it. They believe they have an obligation to provide the necessities. Feeding by a stomach tube, now that would be a different story.

Q) Bentley, who has dementia, signed her living will eight years ago, when she was still competent. She specified she didn’t want any nourishment — liquid or solid food — if there was no expectation of recovery from a physical or mental impairment.

A) Yeah, I think we need to be really careful, because whereas this person has expressed, years ago, that she didn’t want to be kept alive with extreme measures, these are not black and white issues. The health authority feels they are providing the necessities of life, which they feel obliged to do under the law. Obviously court decisions have a role in this. But of course we need to design end of life treatment that gives people quality of life. We’re not talking about assisted suicide.

(Lake starts tearing up here, and pauses, then says:) My mom wanted to die, but while she was alive, we tried to keep her as comfortable as possible so that the time she had, had quality. She died at home, not in hospital. She was surrounded by family. That’s what we need to work toward, to give people a way out with dignity. I struggle and feel for the family, but I also understand legal and ethical obligations.

Q) Isn’t ignoring a patient’s wishes unethical?

A) If they were stomach-tube feeding I would agree.

Q) I’ve heard it said that health region CEOs are really like COOs because they have to follow government directives and don’t have as much autonomy as some might think. But it’s probably not unreasonable that government keeps tight reins on health authorities and that health system leaders are attuned to both costs and quality care. I was surprised recently when I did an interview with a BC Cancer Agency official who didn’t know, off the top of his head, what his program costs were, even though he was the head of the program. He said it would take him 24 hours to get back to me with the figure.

A) This is one of the biggest challenges, keeping the system sustainable. Everything comes down to cost-benefit analysis. Obviously, there are times when money is no object. But you have to justify costs, based on outcomes. CEOs are busy with all their different roles, but they need to be very aware of costs.

Q) You told a reporter during the election campaign that if you were a dog, you’d probably be a terrier. I don’t think that was merely because your first name is Terry. A lot of terrier breeds have a reputation for being pesky, yappy and kind of high-strung. Are those traits you identify with?

A) Terriers are tenacious and tough. They know what they want and how to get it. Plus, I’m not the tallest guy!

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Terry Lake: dad, animal lover and health minister

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